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Generalized Periodic Discharges With Triphasic Morphology in the Setting of Aztreonam Neurotoxicity

Andrew Billnitzer1, Peter W Kaplan2

  • 1Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.

Clinical EEG and Neuroscience
|May 14, 2020
PubMed

Insights

Aztreonam, a beta-lactam antibiotic, can cause neurotoxicity with generalized periodic discharges and triphasic morphology (GPDs + TWm) on EEG. Discontinuation of aztreonam led to the resolution of GPDs + TWm and encephalopathy.

Area of Science:

  • Neuroscience
  • Pharmacology
  • Clinical Neurology

Background:

  • Beta-lactam antibiotics are known to cause neurotoxicity, often presenting with generalized periodic discharges and triphasic morphology (GPDs + TWm) on electroencephalogram (EEG).
  • The neurotoxic mechanism is hypothesized to involve GABA receptor antagonism by the beta-lactam ring.
  • Risk factors for beta-lactam-induced neurotoxicity include advanced age, pre-existing neurological conditions, and impaired renal function.

Observation:

  • A patient with dementia and acute kidney injury developed encephalopathy and GPDs + TWm on EEG after initiation of aztreonam for cystitis.
  • Aztreonam, a beta-lactam antibiotic, has not been previously reported to cause neurotoxicity or GPDs + TWm.
  • The patient presented with multiple risk factors for beta-lactam neurotoxicity.

Findings:

  • This case describes the first report of aztreonam-induced neurotoxicity, characterized by encephalopathy and GPDs + TWm.
  • EEG abnormalities and encephalopathy resolved upon discontinuation of aztreonam.
  • This suggests aztreonam can induce neurotoxic effects similar to other beta-lactam antibiotics.

Implications:

  • Clinicians should consider aztreonam as a potential cause of neurotoxicity, especially in patients with risk factors.
  • Early recognition and discontinuation of aztreonam may lead to favorable neurological outcomes.
  • Further research is warranted to elucidate the specific mechanisms of aztreonam neurotoxicity.
Keywords:
antibioticaztreonambeta-lactamencephalopathygeneralized periodic discharges with triphasic morphologyneurotoxicitytriphasic waves

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